Building Teachers Mental Health Skills to Support Students With Mental Health Needs in Elementary and Middle Schools in North Carolina: Program Implementation and Prospective Data Collection
试验速览
- 阶段
- 不适用
- 状态
- 招募中
- 入组人数
- 312
- 试验地点
- 2
- 主要终点
- Mean Acceptability of Intervention Measure (AIM) Scores
研究概览
简要总结
Purpose: The purpose of this research is to pilot test a novel, alternative, potentially sustainable system of teacher-delivered, task-shifted child mental health care.
Participants: ~300 estimated
Procedures: This is a RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) guided, mixed methods, clustered evaluation of Tealeaf-NC's Reach, Adoption & Implementation (Primary Outcomes, implementation-based), as well as evaluating for preliminary indicators of Effectiveness & Maintenance (Secondary Outcomes, clinically-based).
详细描述
Addressing children's mental health is a critically important health challenge. Twenty percent of all children suffer from significant mental health concerns, most of whom will remain unrecognized, unsupported, and affected throughout their lives. Such wide differences between mental health needs and care access are often called the "care gap". More recently, a youth mental health crisis emerged alongside the COVID-19 pandemic. The adverse impact of the pandemic has led to youth mental health prevalence increasing up to 40% in some global regions, which is double the pre-pandemic rate, while available professional mental health human resources have not changed, leading to an even wider care gap. As urgent solutions are needed, alternative systems of care and support may address this urgent need in a more timely fashion than expanding traditional care systems would.
The overarching goal of this study is to address the youth mental health crisis by providing evidence that high-quality, alternative, sustainable child mental health care may improve youth mental health symptoms. This proposal aims to pilot a novel, alternative, potentially sustainable system of teacher-delivered, task-shifted child mental health care. In North Carolina, USA, the investigators will pilot Teachers Leading the Frontlines - Mansik Swastha [Mental Health in Nepali] (Tealeaf). Created in Darjeeling, India, Tealeaf centers on training and supervising elementary school teachers to deliver "education as mental health therapy" (Ed-MH) to children (ages 5-12). Ed-MH is the investigators' novel, task-shifting, therapy modality that minimizes the time teachers need to deliver care by fitting it into their work. In Ed-MH, teachers use evidence-based therapeutic techniques adapted for use in their existing interactions with students in need (e.g., while teaching) and streamlined for care for any diagnosis ("transdiagnostic").
The investigators' rationale stems from two trials in Darjeeling where the mental health symptoms of children in Tealeaf improved from clinical to neurotypical. The investigators specifically aim to determine if teachers can deliver Tealeaf with fidelity, with positive acceptability & feasibility for stakeholders, and leading to preliminary indicators of improved child mental health outcomes. Guided by the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) public health framework, the investigators hypothesize that a pilot of Tealeaf clustered at the school level will show that:
- Teachers can deliver Tealeaf (task-shifted mental health care fitted into their work) with higher fidelity than the active comparator, and stakeholders (teachers, students, parents, principals) will find Tealeaf more acceptable & feasible than the active comparator (Reach, Adoption, Implementation; Primary Outcomes).
- Tealeaf will show early signs of greater impact on children's 1) mental health symptoms, 2) academic achievement, and 3) school attendance versus a comparator (Effectiveness, Maintenance; Secondary Outcomes).
Researchers will compare Tealeaf with an active comparator, RE-SEED (Responding to Students' Emotions through Education), to see if a lower-resourced version of Tealeaf is viable and/or has an impact.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Health Services Research
- 盲法
- Single (Outcomes Assessor)
盲法说明
Participants will not be blinded; children must assent, and parents consent, to receive mental health care and teachers will be aware they are delivering care. One research assistant (RA) and staff mental health clinician will not be blinded to observe teachers' fidelity. Otherwise, personnel are blinded.
入排标准
- 年龄范围
- 5 Years 至 99 Years（Child, Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Have been trained in either Tealeaf or RE-SEED in Summer 2024 or 2025 after being randomized programmatically
- •Be a school in the State of North Carolina
- •Have an eligible principal
- •Principals:
- •>18 years old
- •Employed at an enrolled school
- •Not suspected or convicted of child-related misconduct or maltreatment
- •>18 years old
- •Employed at an enrolled school
- •Primary teaching responsibility for a single academic class (for a minimum of 1 hour per day and a minimum of 4 days per week) in any grade level Kindergarten to Grade 8
- •Not suspected or convicted of child-related misconduct or maltreatment
- •Counselors:
- •>18 years old
- •Employed at an enrolled school
- •Hold a school counselor position at an enrolled school for at least 10 hours per week
- •Not suspected or convicted of child-related misconduct or maltreatment
- •Enrolled in Kindergarten-Grade 8
- •Student of an enrolled teacher
- •Has a parent or guardian who can provide consent
- •Positive/Clinical-level score on the Strengths and Difficulties Questionnaire (SDQ)
- •>18 years old
- •Guardian of enrolled student
排除标准
- •Exclusion criteria will be set as each participant does not meet the inclusion criteria as set for their group.
研究组 & 干预措施
Tealeaf
Teachers in the Tealeaf arm receive in-depth training and regular supervision and coaching from the study team.
干预措施: Teachers Leading the Frontlines (Behavioral)
RE-SEED
Teachers in the RE-SEED arm receive much less in-depth training. The study team does not provide supervision allowing only the school counselor to provide supervision.
干预措施: Responding to Students' Emotions Through Education (Behavioral)
结局指标
主要结局
Mean Acceptability of Intervention Measure (AIM) Scores
时间窗: Month 0, Month 9
The Acceptability of Intervention Measure (AIM) measures the stakeholder's beliefs about the acceptability of the assigned intervention. Each element is scored from 1 (Completely disagree) to 5 (Completely agree). Mean scores are calculated, with a higher score indicating that the teacher believes the intervention is more acceptable, and a score greater than or equal to 4 indicating positive acceptability.
Mean Intervention Appropriateness Measure (IAM) Scores
时间窗: Month 0, Month 9
The Intervention Appropriateness Measure (IAM) measures the stakeholder's beliefs about the appropriateness of the assigned intervention. Each element is scored from 1 (Completely disagree) to 5 (Completely Agree). Mean scores are calculated, with a higher score indicating that the teacher believes the intervention is more appropriate, and a score greater than or equal to 4 indicating the intervention is more appropriate.
Mean Feasibility of Intervention Measure (FIM) Scores
时间窗: Month 0, Month 9
The Feasibility of Intervention Measure (FIM) measured the stakeholder's beliefs about the feasibility of the assigned intervention. Each element is scored from 1 (Completely disagree) to 5 (Completely agree). Mean scores are calculated, with a higher score indicating that the teacher believes the intervention is more feasible, and a score greater than or equal to 4 indicating positive feasibility.
Mean Cause Analysis Chart (AABC) Evaluation Checklist Scores
时间窗: Month 9
The Cause Analysis Chart (AABC) Evaluation Checklist is a study-specific tool that assists evaluators in scoring the fidelity with which teachers accurately complete the AABC Chart. Mean scores are calculated and can range from 1 (Needs improvement) to 5 (Advanced) with a higher mean score indicating higher fidelity, and an overall mean score greater than or equal to 4 indicating sufficient fidelity.
Mean 4Cs Behavior Plan Evaluation Checklist Scores
时间窗: Month 9
The 4Cs Behavior Plan Evaluation Checklist is a study-specific tool that assists evaluators in scoring the fidelity with which teachers accurately complete the 4Cs Behavior Plan. Mean scores are calculated and can range from 1 (Needs improvement) to 5 (Advanced) with a higher mean score indicating higher fidelity, and an overall mean score greater than or equal to 4 indicating sufficient fidelity.
Mean One-on-One Student Interaction Evaluation Tool Scores
时间窗: Month 9
The One-on-One Student Interaction Evaluation Tool is a study-specific tool that measures the fidelity with which teachers conduct one-on-one sessions with the student(s). Teachers are rated on six domains on a scale that ranges from 1 (Needs Improvement) to 5 (Advanced). Scores are averaged and rounded to a half point across domains to yield mean scores from 1 to 5 with a mean higher score indicating higher fidelity, and a mean score greater than or equal to 4 indicating sufficient fidelity.
Mean One-on-One Family Interaction Evaluation Tool Scores
时间窗: Month 9
The One-on-One Family Interaction Evaluation Tool is a study-specific tool that measures the fidelity with which teachers conduct family interactions. Teachers are rated on six domains on a scale that ranges from 1 (Needs improvement) to 5 (Advanced). Scores are averaged and rounded to a half point across domains to yield mean scores from 1 to 5 with a mean higher score indicating higher fidelity, and a mean score greater than or equal to 4 indicating sufficient fidelity.
次要结局
- Change in Strengths and Difficulties Questionnaire Total Difficulties Score(Month 0, Month 9)
- Mean Proportion of Attendance(Up to 18 months)
- Change in Academic Achievement(Up to 18 months)